In life, we often arrange complicated, tailor-made services to suit our preferences and needs. Home renovations, travel, or weddings come to mind. We spend time designing what we want with architects, travel agents, and wedding planners. Often these agents act with and for us to arrange services to suit us.
A contract is negotiated, prices are agreed, the services are monitored as they are delivered and adjusted if need be. We want those delivering the service to be responsive to what we want, help us to solve problems, and value their relationship with us. Ultimately, if things go wrong, we can refuse to pay unless problems are fixed. But mostly, builders, hotels, and wedding venues value their reputation and work hard to avoid this happening. They know word-of-mouth referrals and comments on comparison websites can have a big impact – positive or negative – on their future business.
When it comes to planning an event like a wedding, we expect a tailor-made service.
This is nothing like what happens when older Australians need aged care services. In aged care, our needs are opaquely and bureaucratically assessed by remote bureaucrats in something called an Aged Care Assessment Team. Then the government hands out a predetermined amount of money to the service providers based on that assessment, and, like Procrustes’ bed, we have to fit the services that are available. We get what we are given.
We do not design a tailor-made plan to meet our preferences. Nor do we have individual agreements and contracts that specify what we are getting so we can hold service providers to their obligations. We do not have agents working with us to negotiate services or solve problems. When things go wrong we can’t withhold payment. Instead we have to complain through a cumbersome, slow, and distant bureaucracy.
The service providers hold all the cards. The aged care royal commission has highlighted how that can lead to truly disgracefully bad outcomes for older people. But not enough has been made of the banal, everyday lack of responsiveness to individual preferences, goals, and desires. Even in ‘good’ residential care homes, the physical environment, meals, social and personal relationships, and recreational activities are highly institutionalised. Not surprisingly, almost no one wants to go there.
Even in ‘good’ residential care homes, the physical environment, meals and recreational activities are highly institutionalised.Credit:Getty
A one-size-fits-all, take-it-or-leave-it approach is no longer acceptable in any other service area. It should no longer be acceptable for the systems which support older Australians.
The whole aged care system needs to be transformed from one where the legislation is about central control – of how many places, who provides care, and where – to one which is about responding to each individual’s preferences and needs. In a recently released Grattan Institute report, we call this a ‘rights-based’ approach.
The negotiation and delivery of an individual agreement between an older person who wants care and support and those providing services should be central to aged care. Like other contracts, agreements should specify the services that are going to be provided, the payments for these services, and what will happen if obligations are not met.
Unfortunately, aged care funding design has been more focused on managing the cost of care for government and service providers, than making sure older people get the services they need. Funding should be tied to individual agreements.
This is not to say that the cost of care doesn’t matter. The community is paying for aged care and has a right to expect that services provided are reasonable and necessary. Nor should providers be able to charge whatever they like for services. There should be checks and balances to monitor the individual service agreements that are negotiated, and there should be fair and efficient price schedules for services. Providers should be more accountable for quality too.
It is also true that older people are not always able to design and negotiate individual service agreements when they develop disabilities and impairments. Then they should have access to agents who can act on their behalf to design and negotiate the service plan, select providers, and monitor services so they get what they need and want, whether those services are provided in their home or in supported accommodation.
Fundamentally, it is difficult to see the aged care system meet its promise to older people unless individual agreements for the delivery of care are more like what we expect for other complex services and projects in our lives.
The royal commission on aged care has uncovered terrible stories about what is happening to older Australians. More money is necessary but is not sufficient. We need to redesign the aged care system from the ground up, with the rights of older Australians paramount.
Hal Swerissen and Stephen Duckett are with the Health Program at Grattan Institute.
Most Viewed in National
Source: Read Full Article